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Pancreatology. 2017 Sep - Oct;17(5):732-737. doi: 10.1016/j.pan.2017.07.005. Epub 2017 Jul 12.

Prevalence and predictors of pain and opioid analgesic use following total pancreatectomy with islet autotransplantation for pancreatitis.

Author information

1
Pancreatitis Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
2
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
3
Pancreatitis Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
4
Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
5
The Comprehensive Transplantation Unit, Johns Hopkins University School of Medical, Baltimore, MD, USA.
6
Division of Surgical Oncology, Department of Surgery, Johns Hopkins University School of Medical, Baltimore, MD, USA.
7
Division of Endocrinology, Diabetes, & Metabolism, Johns Hopkins University School of Medical, Baltimore, MD, USA.
8
Pancreatitis Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Abdominal Imaging, Department of Radiology, Johns Hopkins University School of Medical, Baltimore, MD, USA.
9
Pancreatitis Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: vsingh1@jhmi.edu.

Abstract

BACKGROUND & OBJECTIVES:

Total pancreatectomy with islet autotransplantation (TPIAT) is employed for the management of refractory pain in chronic pancreatitis (CP) with the prospect of partial beta cell preservation. The primary aim of this study is to evaluate the prevalence and predictors of abdominal pain and opioid use following TPIAT.

METHODS:

A single center cohort study of all adult patients who underwent TPIAT from 2011 to 2015 for CP. Postoperative pain outcomes included: opioid use, ongoing abdominal pain and new characteristic abdominal pain. Multiple logistic regression analysis was used to evaluate known and potential predictors of postoperative pain outcomes.

RESULTS:

During the study period, 46 patients underwent TPIAT. Following surgery, 89% of patients had resolution of their pre-operative abdominal pain; however, 83% of patients developed a new characteristic abdominal pain. Opioid independence was achieved in 46% of patients. Acute recurrent pancreatitis (ARP) (OR: 11.66; 95%CI: 1.47-92.39; p = 0.02) but not pain duration >3 years or ≥ 5 ERCPs was independently associated with resolution of pre-operative abdominal pain on multiple logistic regression. None of these factors were associated with cessation of opioid use.

CONCLUSION:

While the majority of patients have resolution of their initial abdominal pain following TPIAT, many will also develop a new characteristic abdominal pain and only half of all patients achieve opioid independence. ARP is the only independent factor associated with positive postoperative pain outcomes and should be considered a standard criterion for patient selection.

KEYWORDS:

Chronic pancreatitis; Opioid analgesics; Pain; Surgery; TPIAT

PMID:
28733148
DOI:
10.1016/j.pan.2017.07.005
[Indexed for MEDLINE]

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